Rapid Bilateral Visual Loss as the Initial Clinical Manifestation in Idiopathic Hypertrophic Cranial Pachymeningitis

Shao W, Tian C, Gao L, Cui B and Shi Q

Department of Ophthalmology, the Third Medical Center of PLA General Hospital, China

^*Correspondance to: Weiyang Shao 

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Abstract:

Purpose: To describe a patient presented rapid bilateral visual loss as the initial clinical manifestation in idiopathic hypertrophic cranial pachymeningitis. Case Report: A 59-year-old male patient presented with 4-day acute painless bilateral visual loss, with no headache, eye distension, photophobia, lacrimation or diplopia. Upon examination, the Best-Corrected Visual Acuity (BCVA) of the right eye was Hand Movement (HM), and the left eye demonstrated nothing in Light (NIL). The pupils of both eyes were round, the pupil diameter of the right eye was 2.5 mm, and that of the left was approximately 5 mm. More, the right eye showed a Relative Afferent Pupillary Defect (RAPD), and both the direct and indirect light reflexes of the left eye had disappeared. Other examinations including Color fundus, macula and optic disc photography and laboratory tests were negative. Imaging tests, including Magnetic Resonance Enhancement Imaging (MRI) were performed with dural enhancement along the floor of the anterior fossa. The patient was considered to have Idiopathic Hypertrophic Cranial Pachymeningitis (IHCP) based on laboratory tests and MRI data. After implosive treatment with hormones, the visual acuity of the patient obviously improved. Conclusion: IHCP is a chronic inflammatory disorder characterized by diffuse thickening of the dura. A few patients present with bilateral or unilateral moderate visual loss. We report the case of an IHCP patient who presented with sharp bilateral visual loss as the initial clinical symptom, without any other typical positive manifestations. To our knowledge, this is a rarely reported case about IHCP disease.

Keywords:

Idiopathic hypertrophic cranial pachymeningitis; Visual loss; Dural thickening

Cite the Article:

Shao W, Tian C, Gao L, Cui B, Shi Q. Rapid Bilateral Visual Loss as the Initial Clinical Manifestation in Idiopathic Hypertrophic Cranial Pachymeningitis. Clin Case Rep Int. 2022; 6: 1284.